CASE EXAMPLE “DEPRESSION KILLS MORE THAN A SELF”

Feroza, a young Pakistani woman in her thirties, came to England eight years ago after

marriage to a second generation British Pakistani. She clearly recognised the vignette as

depression. Below is an edited version of her description of her personal experience of

depression."^^

"She has depression. She is saying her body aches, but m aybe the do cto r w ould say she

is okay health wise This happens to me also. I went to the doctor tw o weeks ago and

told him that (I) stay very tired. What happens is that, I keep falling asleep even during prayers... it is very difficult. He on seeing me told me I looked anaemic, "your colour is very yellow". He prescribed me with some tablets and told me to make an appointm ent fo r a blood test. They did the blood test but now say that I am com pletely okay, I am not anaemic. (My) body aches all the time, (my) back aches since my la st pregnancy and (my) body f e e ls weak all the time. M y colour is yellow, even the do cto r sa id I looked anaemic, but they d id test and the tests are okay.

[So what do you think is wrong with you?] This depression. Look, my parents, brothers

and sisters are in Pakistan, I have nobody here. It is me alone. When a g irl gets m arried she leaves everyone f o r her husband and his fam ily, then when her husband isn't g ood with her and isn't aw are o f his responsibilities then obviously depression happens. You have no im portance and when (you) can't see any importance o r value to yo u r own life then distress does happen.] Then (you) are away from (your) parents you can only write a letter or phone once in a while. Even if you phone there is a financial issue. When you live alone with your husband it is a different matter, but when you live with in-laws, with fam ily you have to live very depressed in case they take anything badly, " why you have taken longer in doing this then you said". These m arriages within fam ilies bring many issues.

'^‘"The quotes given in this chapter are translations of the Urdu versions. In these translations emphasis was placed on retaining the conceptual essence of what the respondents were saying. The English versions consequently reflect this.

Then when you get married it is never that both parents agree, one agrees and the other doesn't. This happened to me as well. Then when anything goes wrong it leads to disagreements. The domestic atmosphere can never be right. The one that wasn't happy about the match keeps an eye on every little thing, the sm allest thing they use as a target and exaggerate it. The domestic atm osphere w ill obviously be bad. The husband - it is his mother. It is bad if he does anything wrong or says anything wrong to his mother. The mother has her status, she has more rights on her son than even a father. So then if I say anything, "that this happened, that happened" then slowly slowly disputes will obviously happen. He should be aware and think him self how he will balance these things. The m other is in her place, the wife is in hers and with her there are children. If we have tension between us then what effect will it have on the children ? They are sm all but they understand everything.

And then there is work to do as well. If you are happy it doesn't m atter how much work you have to do. To me it always seems too much. When the children's holidays are

approaching I already have tension - that what will I do, they will irritate me. It all

depends on your mood. They come from school and they fig h t so much. I have essential things to do, work in the kitchen, in the house. If I go to the bathroom he will hit her and she will hit him. Because o f them I also have depression, they irritate me a lot. There is house work to do and children's work to do also - clothing them, feedin g them, everything. The torture o f work also causes depression. But I think if a person is happy everything is happy. Then even the most work is nothing. If my husband's m ood is g o o d I f e e l my day has p a sse d well, if it is ba d then it all goes wrong. It comes out f o r no reason on the children. Then I think I am doing wrong and I regret it. One minute I hit them and the next minute I cuddle them. They are only children, but you can't take you r anger out elsew here and then by itself no m atter how much control you do it com es out

on them. If children grow up in such an environment, seeing their parents tension my

oldest son, he isn't very big but he understands everything. A ll these things effect their personality from the day they are bom . I f (we) stay sa d and d istressed all the time then

My husband doesn't understand, he has his own problem s. When we g o t m arried.... he is my Chachas (father younger brothers) son. His fa th er was happy with the marriage, but the mother wanted someone from her side o f the fam ily. He (husband) liked me, but his m other didn't want me. He understood it all, he wanted to be m arried but he also

d idn 't want to be married. In this confusion he also stayed very depressed he is

trapped in his own situation. Then on top o f that there are marital responsibilities. Up until now that atmosphere, which there should be in a home after m arriage, isn't there. A ll these things have caused depression.

[So what are the signs of depression?] Crying, the body is tired and exhausted. I fe e l

tired myself. Whenever (I) go to the doctor he says it is nothing, I am okay, I am healthy. A persons fa c e shows it all. People can recognise from their fa c e that they are in depression. Some people you will have seen are not much health wise, they have illness. Now me (I) have no gas, no blood pressure, asthma isn't in me, no illness, but the colour in my fa ce isn't right. I am absolutely okay, I have no illness. And then there are some people who are ill, but from their fa ce they look fin e and happy. D epression kills more than a self.

[Is it an illness in itself?] No it is not, we have created it ourselves. Our circum stances

create it. It is nothing by itself Because o f it something or the else gets created. The other woman that I told you about in Pakistan - she has been ill all her life and now they say she has no illness - ju s t psychological.

[What is the cure f o r it in your opinion] Whoever keeps faith in G od depression cannot happen to. When I p ra y or read Quran I fe e l my G od is with me, even though I am alone. When I have my periods*^ and I can't pray then I have it more. A fter all, a person is alone, you want someone who cares about you that you can tell things to, w hat is in your heart. M ost sincere are parents, brothers and sisters, but then they have their own also. Sisters care, but then brothers...there are sister in laws and you f e e l differently.

47i

Women in Islam are prohibited from praying or handling the Quran during menstruation.

But most parents do. Over here (in Britain - away from home) who can you think is your

own, (you) can't talk to anyone as (you are) scared that they may tell you r in laws. Then that will become a problem . In laws ju st need one thing to becom e an issue. So many

things cause depression I have true fa ith in G od - then happiness is fro m him and

d istress is from him, from this depression decreases a lot.

D rs can't do anything, it is ju st your dom estic atmosphere....Look, my doctor he is ju s t seeing it physically, I am telling him (I) am tired, (I) can't do anything, (I) sleep a

lot. Everyone knows a sign o f depression is exhaustion, but he isn't understanding....

I f someone is your confidante then it is your parents. But then husband can give love also. If my husband was okay my depression would not stay. When I go out to classes o r somewhere I am fine, but when I am at home it starts again.

Feroza's description of depression highlighted sonæ of the cultural themes that shaped and

made meaningful her experience of distress. She raised many of the cultural themes that

were also discussed by many of the other respondents, as will be seen during the course

of this Chapter. For example, although Feroza used the term depression frequently her use of it was always 'objective' as opposed to 'subjective'. That is, she referred to

'depression' but not being 'depressed'. When she described her symptoms they were predominantly physical, but in her description these symptoms did not preclude her

underlying awareness of her own unhappiness. Feroza was clearly aware of the many

causes of her depression. She located these in her role within relationships, the pressures of being a daughter-in-law, a strained marital relationship, the pressures of having young

children and housework. A further cause of Feroza's depression was lack of support,

which she associated with her parents and sisters, back in Pakistan. The elaborate

descriptions of kinship and hierarchy were central to her experience and expression of distress. When she talked of venting her tensions on her children, it was a reflection of

the limitations of her role and particular situation bring in expressing her distress with her

husband or in-laws. In her description Feroza defined herself very much in terms of

function and her relationship to others. Given her clear understanding of her own state,

Such culturally shaped conceptions of; personhood, the importance of familial

relationships, the connection between the psychological and the somatic, all featured in many of the respondents descriptions of; symptoms, consequences, causes and curative

measures for distress / depression. It is the very shared nature of these conceptions

(moreover language) that make experiences of distress, both personally and socially,

meaningful. When these conceptions are not shared, as was seen in Feroza's case with

her doctor, it is then that problems arise.

Using content analytic results and exct^bof respondents descriptions the intricacies and

inter-play of cultural themes which shape experiences like Feroza are discussed. An

attempt is thereby made to build a Pakistani explanatory model of distress / depression and

to explicate the cultural network of meaning associated with it.